Date: December 16, 2022
To: Enrolled Physicians; Advanced Practice Nurses; Physician Assistants; Federally Qualified Health Centers; Rural Health Clinics; Encounter Rate Clinics; Local Health Departments; Hospitals; and School-Based/Linked Health Centers
Re: Update Regarding the COVID-19 Uninsured Portal
This notice contains updates for providers billing COVID testing, vaccine administration, and medication treatment claims for the uninsured population.
In previous provider notices dated August 2, 2022 and October 6, 2022, the Department of Healthcare and Family Services (HFS) informed providers that the COVID Uninsured Portal is not currently operational to assign RINs or process claims for uninsured patients. Portal function has not yet resumed, but at the time it does, the claim generation utility will no longer be available. All claims will have to be billed through the provider's usual claim submittal process outside the portal.
HFS has previously informed providers that if they have identified a RIN already assigned to an uninsured patient that has "COVID 19 Testing Only" coverage on the date of service, the provider should bill any claims to HFS through the provider's usual claim submittal process outside the portal.
As clarification, hospitals must use the 837I format for COVID testing and monoclonal antibody claims submitted. Hospitals are allowed to bill as an exception on the 837P for COVID vaccine administration in accordance with the April 8, 2021 provider notice.
Regular timely filing exception rules will apply for claims billed outside of the portal. Providers needing a timely filing exception must submit an HFS 1624 Override Request form or the HFS 1624A UB-04 Override Request form to the electronic Attachment Upload Portal for review.
At the time the COVID Uninsured Portal does resume function, only the RIN generation utility will remain. To request a RIN, providers will be required to submit comprehensive patient data, including the following:
- Birth Date
- Social Security Number (SSN) (if patient has one)
The SSN is a vital identifier in terms of HFS examining multiple RINS assigned through the portal for the same person. Providers need to obtain SSNs from their patients who have them. HFS is currently working on a process to reliably identify uninsured patients for which there are no SSNs.
All claims for the uninsured population must contain a diagnosis code indicating the patient encounter was for the purposes of COVID testing, COVID vaccine administration, and/or COVID medication treatment. Paid claims with no COVID or COVID-related diagnosis code are subject to post-payment review and recoupment.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5564.
Kelly Cunningham, Administrator
Division of Medical Programs